/policies/,/policies/clinical/,/policies/clinical/uwmf-clinical/,/policies/clinical/uwmf-clinical/uwmf-wide/,/policies/clinical/uwmf-clinical/uwmf-wide/clinical-policies-and-procedures/,/policies/clinical/uwmf-clinical/uwmf-wide/clinical-policies-and-procedures/urologic/,

/policies/clinical/uwmf-clinical/uwmf-wide/clinical-policies-and-procedures/urologic/102139.policy

201411307

page

100

UWMF,

Policies,Clinical,UWMF Clinical,UWMF-wide,Clinical Policies and Procedures,Urologic

Cystoscopy with Bladder Biopsy (102.139)

Cystoscopy with Bladder Biopsy (102.139) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Urologic

102.139

1
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: CYSTOSCOPY WITH BLADDER BIOPSY

Effective Date: January, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed November 2007 May 2009 March 2012

PURPOSE: To provide guidelines for the preparation and follow-up of patient undergoing a cystoscopy with bladder
biopsy at UWMF Clinics.

DEFINITION: A cystoscopy with bladder biopsy is performed to diagnose lesions or growths in the bladder, including
bladder cancer.

POLICY: The clinical staff will utilize the following guidelines to prepare a UWMF patient for a cystoscopy with
bladder biopsy.

SUPPLIES: Provider’s order, Patient’s record, Flexible or rigid bugby
Use supply list from cystoscopy male or female
For rigid will use 21 Fr obturator and sheath
Rigid or flexible biopsy forcep (for flexible will need adaptor), Cautery machine and cautery cord,
grounding patch
Formalin container, biohazard specimen bag, patient’s lab slips
Consent “Cystoscopy with Bladder Biopsy”

Pre-Procedure
1. Verify provider order.

2. Review and follow procedure for male or female cystoscopy.

3. Wash hands, gather equipment and set up as described.

4. Place grounding patch on patient’s leg, turn machine on and place foot pedal where physician will stand.

5. Attach cautery cord to cautery machine.

6. Place forcep and bugby on tray with cystoscope using sterile technique.

7. Attach bugby to cautery cord and drape over patient’s leg.

During procedure
1. Turn off lights once provider has inserted scope.

2. Wash hands and put on sterile gloves.

3. Ensure patient is comfortable and assist physician (as needed).

4. Put tissue samples in formalin container. Label containers with at least two patient identifiers (full name, DOB,
MRN). Enter order into computer per provider preference. Send specimens to lab.

After procedure
1. Assist patient to sitting position, offer bathroom, assist with dressing (if needed).


2
2. Clean scopes, forceps and bugby in Metrizyme solution.

3. Soak scopes and bugby in Metricide for 20 minutes.

4. Rinse scopes and bugby in sterile water basin and wrap in sterile towels.

5. Place forceps in autoclave pouch for sterilization.

6. Clean tray, counters and table with Dispatch.

7. Empty and clean drain (if used).

8. Label specimen and lab slips properly and bring specimen to lab.

9. If ordered, administer prescribed antibiotic prophylaxis. This varies with MD.

10. Discharge instructions as per cystoscopy protocol
May experience frequency, dysuria or hematuria.

11. Documentation (in Progress Notes section of HealthLink) in the patient’s record:
Patient education
the procedure performed, date & time completed
name and amount of any medications given (using SmartPhrase: .medinclinic)
how patient tolerated procedure
discharge instructions
follow-up appointment (if any)


WRITTEN BY: Deb Brausen, R.N., Manager, Department of Urology
Tracy Ancheta R.N., Department of Urology
Leslie Calkins, R.N., Department of Urology
Gail Jahnke, R.N., N.P., Department of Urology

REVIEWED BY: Donnette Kelly, R.N., Department of Urology, 2012
Carol Decker, RN, MSN, Clinical Staff Educator, 2012


AUTHORIZATION:


Department of Surgery, Urology Date



Medical Director Date